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WHO Director-General's opening remarks at the media briefing on COVID-19 - 20 March 2020

Good morning, good afternoon and good evening, wherever you are.

Every day, COVID-19 seems to reach a new and tragic milestone.

More than 210,000 cases have now been reported to WHO, and more than 9,000 people have lost their lives.

Every loss of life is a tragedy. It’s also motivation to double down and do everything we can to stop transmission and save lives.

We also need to celebrate our successes. Yesterday, Wuhan reported no new cases for the first time since the outbreak started.

Wuhan provides hope for the rest of the world, that even the most severe situation can be turned around.

Of course, we must exercise caution – the situation can reverse. But the experience of cities and countries that have pushed back this virus give hope and courage to the rest of the world.

Every day, we are learning more about this virus and the disease it causes.

One of the things we are learning is that although older people are the hardest hit, younger people are not spared.

Data from many countries clearly show that people under 50 make up a significant proportion of patients requiring hospitalization.

Today, I have a message for young people: you are not invincible. This virus could put you in hospital for weeks, or even kill you.

Even if you don’t get sick, the choices you make about where you go could be the difference between life and death for someone else.

I’m grateful that so many young people are spreading the word and not the virus.

As I keep saying, solidarity is the key to defeating COVID-19 - solidarity between countries, but also between age groups.

Thank you for heeding our call for solidarity, solidarity, solidarity.

We’ve said from the beginning that our greatest concern is the impact this virus could have if it gains a foothold in countries with weaker health systems, or with vulnerable populations.

That concern has now become very real and urgent.

We know that if this disease takes hold in these countries, there could be significant sickness and loss of life.

But that is not inevitable. Unlike any pandemic in history, we have the power to change the way this goes.

WHO is working actively to support all countries, and especially those that need our support the most. 

As you know, the collapse of the market for personal protective equipment has created extreme difficulties in ensuring health workers have access to the equipment they need to do their jobs safely and effectively.

This is an area of key concern for us.

We have now identified some producers in China who have agreed to supply WHO.

We’re currently finalizing the arrangements and coordinating shipments so we can refill our warehouse to ship PPE to whoever needs it most.

Our aim is to build a pipeline to ensure continuity of supply, with support from our partners, governments and the private sector. I am grateful to Jack Ma and his foundation as well as Aliko Dangote for their willingness to help provide essential supplies to countries in need.

To support our call to test every suspected case, we are also working hard to increase the global supply of diagnostic tests.

There are many companies globally that produce diagnostic kits, but WHO can only buy or recommend kits that have been evaluated independently, to ensure their quality.

So we have worked with FIND – the Foundation for Innovative New Diagnostics – to contract additional labs to evaluate new diagnostics.

In parallel, we’re working with companies to secure the supply and equitable distribution of these tests.

And we’re also working with companies to increase production of the other products needed to perform the tests, from the swabs used to take samples to the large machines needed to process them.

We’re very grateful for the way the private sector has stepped up to lend its support to the global response.

Just in the past few days I’ve spoken with the International Chamber of Commerce, with many CEOs through the World Economic Forum, and with the “B20” group of business leaders from the G20 countries.

We understand the heavy financial toll this pandemic is taking on businesses and the global economy.

We’re encouraged by the solidarity and generosity of business leaders to use their resources, experience and networks to improve the availability of supplies, communicate reliable information and protect their staff and customers.

And we’re also encouraged that countries around the world continue to support the global response. We thank Kuwait for its contribution of 40 million U.S. dollars.

In addition to increasing access to masks, gloves, gowns and tests, we’re also increasing access to the evidence-based technical guidance countries and health workers need to save lives.

WHO has published guidelines for health ministers, health system administrators, and other decision-makers, to help them provide life-saving treatment as health systems are challenged, without compromising the safety of health workers.

The guidelines detail actions all countries can take to provide care for patients, regardless of how many cases they have. They also outline specific actions to prepare health systems, according to each of the “4 Cs” – no cases, sporadic cases, clusters of cases, and community transmission.

These guidelines provide a wealth of practical information on screening and triage, referral, staff, supplies, standard of care, community engagement and more.

We encourage all countries to use these and the many other guidelines, which are all available on the WHO website.

But we’re not only advising countries. We also have advice for individuals around the world, especially those who are now adjusting to a new reality.

We know that for many people, life is changing dramatically.

My family is no different – my daughter is now taking her classes online from home because her school is closed.

During this difficult time, it’s important to continue looking after your physical and mental health. This will not only help you in the long-term, it will also help you fight COVID-19 if you get it.

First, eat a health and nutritious diet, which helps your immune system to function properly. 

Second, limit your alcohol consumption, and avoid sugary drinks.

Third, don’t smoke. Smoking can increase your risk of developing severe disease if you become infected with COVID-19.

Fourth, exercise. WHO recommends 30 minutes of physical activity a say for adults, and one hour a day for children. 

If your local or national guidelines allow it, go outside for a walk, a run or a ride, and keep a safe distance from others. If you can’t leave the house, find an exercise video online, dance to music, do some yoga, or walk up and down the stairs.

If you’re working at home, make sure you don’t sit in the same position for long periods. Get up and take a 3-minute break every 30 minutes.

We will be providing more advice on how to stay healthy at home in the coming days and weeks.

Fifth, look after your mental health. It’s normal to feel stressed, confused and scared during a crisis. Talking to people you know and trust can help.

Supporting other people in your community can help you as much as it does them. Check in on neighbours, family and friends. Compassion is a medicine.

Listen to music, read a book or play a game.

And try not to read or watch too much news if it makes you anxious. Get your information from reliable sources once or twice a day.

To increase access to reliable information, WHO has worked with WhatsApp and Facebook to launch a new WHO Health Alert messaging service.

This service will provide the latest news and information on COVID-19, including details on symptoms and how to protect yourself.

The Health Alert service is now available in English and will be introduced in other languages next week.

To access it, send the word "hi" to the following number on WhatsApp: +41 798 931 892. We will make this information available on our website later today.

COVID-19 is taking so much from us. But it’s also giving us something special – the opportunity to come together as one humanity – to work together, to learn together, to grow together.

I thank you.

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• Published: 01 February 2022

Persuasive narrative during the COVID-19 pandemic: Norwegian Prime Minister Erna Solberg’s posts on Facebook

• Sanjana Arora   ORCID: orcid.org/0000-0003-0107-7061 1 ,
• Jonas Debesay 2 &
• Hande Eslen-Ziya   ORCID: orcid.org/0000-0001-7113-6771 1  

Humanities and Social Sciences Communications volume  9 , Article number:  35 ( 2022 ) Cite this article

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• Cultural and media studies
• Politics and international relations

This article explores the Facebook posts of Norway’s Prime Minister Erna Solberg to highlight the key features of her crisis communication during the COVID-19 pandemic. It draws on data from Solberg’s Facebook posts from February 27, 2020 to February 9, 2021 (i.e., starting from the day when the first case of COVID-19 was recorded in Norway until the time of data collection for this study). Out of her 271 posts, 157 of them were about COVID-19 and were chosen for analysis. The analyses identified five major themes: (1) Promoting responsibility and togetherness (2) Coping (3) Being in control amidst uncertainty (4) Fostering hope and (5) Relating with the followers. Drawing inspiration from Boin, Stern and Sundelius’, work on persuasive narratives, this study shows the ways that Solberg’s posts about COVID-19 exhibit all five identified frame functions. In addition, the findings add contextual nuances to the frame functions through the theme of ‘Responsibilization and togetherness’, which are reflected through references to Norwegianness and the cultural concept and practice of dugnad . This study adds to our knowledge about how persuasive narratives are incorporated into the social media communication strategies of leaders and highlights the usefulness of this framework for studying ongoing and future crises.

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Introduction.

The economic and social disruption caused by the COVID-19 pandemic is having major impacts on people’s livelihoods and their health. As of 18 April 2021, there have been 140,322,903 confirmed cases of SARS-CoV-2 infections and 3,003,794 deaths (WHO, 2021 ), making the COVID-19 pandemic an unprecedented global health crisis of the century. As countries across the world grapple with mitigating the risks associated with the pandemic, communication—an essential component of planning, response, and recovery during crisis (Houston et al., 2014 )—has been one of the integral parts of the crisis management (Reddy and Gupta, 2020 ). Crisis communication highlights legitimation strategies, but also indicates how government institutions themselves make sense of crises (Brandt and Wörlein, 2020 ). Moreover, crises such as the COVID-19 pandemic can disrupt the socio-political order of societies, leaving a cognitive void in the minds of the public that can be filled with fear and uncertainty (Boin et al., 2016 ). In Norway, COVID-19 has been called a fear-driven pandemic that is based on alarming information of long-term illness and disability that is out of politicians control (Vogt and Pahle, 2020 ). Having control over the dramaturgy of political communication is thus central to effective leadership and crisis management (Boin et al., 2016 ). Effective communication can help societies handle uncertainty and promote adherence to behaviour change while fostering hope among the citizens (Finset et al., 2020 ).

The COVID-19 pandemic continues to rapidly evolve, and social media plays a pivotal role in meeting the communication needs of the public during such crisis (Van Dijck, 2013 ). As social media use increases during crises, leaders and public officials may utilise this platform to communicate, which in return helps reduce public panic and builds trust (Kavanaugh et al., 2012 ). As a result of the cultural and symbolic value of social media in contemporary times (Jenzen et al., 2021 ), the communication of public leaders in the midst of uncertainty and fear facilitates interpersonal and group interaction. Research has shown that, when compared to the traditional media platforms, social media platforms are used by leaders and elected officials to communicate, inform, and engage with their citizens (Golbeck et al., 2010 ). They use social media to spread messages farther and faster than it would be possible with traditional media (Sutton et al., 2013 ). What leaders post on social media can give insights into their communication and leadership strategies during crises. Understanding how leaders communicate with the public during crises will not only provide us with the knowledge about their governance styles but will also guide us to their meaning-making in times of uncertainty. Based on this assumption we will be studying the Facebook posts of Norwegian Prime Minister Erna Solberg, with the aim to highlight the key features of her communication. In doing so, we will take an exploratory rather than confirmatory perspective (Boudreau et al., 2001 ).

Solberg, member of the Conservative Party and in power since 2013, was defeated by the centre-left as this paper was being revised. Solberg has had a long career in politics, becoming a deputy representative to the Bergen City Council in 1979 when she was 18 years old. She was elected to the Parliament in 1989 where she was the youngest member of her party group (Notaker and Tvedt, 2021 ). Solberg’s tough stance on issues such as immigration earned her the nickname of ‘Jern-Erna’ [Iron Erna] (Reuters, 2013 ). However, upon her appointment as Prime Minister, Solberg displayed a ‘softer side’ by caring about voters’ jobs, health, and schools (Notaker and Tvedt, 2021 ).

The first Norwegian COVID-19 patient was diagnosed on February 26, 2020. While the initial spread of infection was relatively slow, cases increased quickly by March 12 th , after winter break for schools ended and many Norwegians returned from skiing holidays in Northern Italy (Dagsavisen, 2020 ). On March 12, the Norwegian Directorate of Health (NDH) adopted comprehensive measures to prevent the spread, which included closing day care centres, schools, and educational institutions. The measures also included a ban on cultural events, closed swimming gyms and pools, a halt to all service provisions that involved being less than one meter away from another person, and prohibiting visits to recreational cabins Footnote 1 , among others. Behavioural measures such as recommendations to keep physical distance, encourage handwashing, quarantine, stay home when ill, work from home, and avoid public transportation were also included. Following the lockdown, Norway became the first European country to announce that the situation was under control due to low levels of hospitalizations and mortalities (Christensen and Lægreid, 2020 ). In Norway, as of March 22, 2021, there have been over eighty thousand confirmed cases of coronavirus infection and more than six hundred deaths due to COVID-19. Norway has had far fewer COVID-19 cases, deaths, and hospitalizations per capita than most other countries in Western Europe or the United States (Christensen and Lægreid, 2020 ). Compared to its Scandinavian neighbours Denmark and Sweden, the proportion of cases of infections and deaths have been much lower (WHO, 2021 ), despite the three countries sharing similar social welfare and healthcare systems. Recently, a report submitted by the Corona Committee in Norway also concluded that the overall handling of the crisis by the government has been good. Not only has the number of infections and deaths in Norway been much lower than most countries in Europe, but the healthcare services have also remained stable, and society has remained relatively open (Lund, 2021 ). It is probable that good governance and responsible leadership demonstrated by the Norwegian cabinet and Prime Minister Erna Solberg contributed to this success.

In Norway, there is considerably less focus on individualization of candidates in political parties as compared to for instance the US, since the electoral system in Norway is based on proportional representation (Karlsen and Enjolras, 2016 ). Despite this, with the presence of digital and social media, there has been increasing focus on the individual candidates, leading to ‘decentralising personalisation’ (Karlsen and Enjolras, 2016 ; Balmas et al., 2014 ). Given this context, Erna Solberg’s Facebook account during the COVID-19 pandemic serves as an intermediary platform between the government’s role and her own personal profile as the Prime Minister who has been handling the COVID-19 crisis. Solberg has used Facebook more actively than other outlets like Twitter and has more followers on Facebook than any other platform. The proportion of Facebook users in Norway vis-a-vis other social media platform is also the highest (for example, 84% of people use Facebook compared to 22% who use Twitter who use Twitter) (Werliin and Kokholm, 2016 ). Facebook thus serves as an important platform for public leaders in Norway during crises, and therefore, by analysing Solberg’s Facebook posts, we aim to demonstrate the key features of her communication strategy during the COVID-19 crisis.

Background on crisis and crisis communication

Crisis is defined as a rare, and significant public situation creating undesirable consequences (Coombs, 2015 ; Gruber et al., 2015 ). In most cases it is ‘an unpredictable event that threatens important expectancies of stakeholders and can seriously impact an organization’s performance and generate negative outcomes’ (Coombs, 2015 : p. 3). Crisis communication on the other hand is referred as the strategies used to lessen the uncertainties during crisis via the dissemination and exchange of information (Collins et al., 2016 ). Effective crisis communication establishes reliability and maintains public trust. It should be frequent, consistent and involve compassionate messages conveyed in an inspired and transformational communication style. It is essential that public officials and leaders when communicating crisis relevant information be efficient and informative. Past research has shown the importance of repetition of the consistent interaction to help the message reach the recipients clearly and increase compliance behaviour in cases of crisis (Stephens et al., 2013 ). Inconsistent messages on the other hand were found to cause misperception and confusion, leading to a non-compliant behaviour by the recipients. The content of the message as well as its tone is also an important indicator of whether the recipients will comply or not (Sutton et al., 2013 ). Sources of crisis communication, such as leaders and public health officials, are perceived to be reliable and trustworthy when they exhibit concern and care (Heath and O’ Hair, 2010 ). In addition, they can be more effective in building relationship with the public, if they consider the cultural factors that play a role in their communicating about risks (Aldoory, 2010 ).

Boin et al. ( 2016 ) argue that crisis communication is one of the key challenges, which leaders face during a crisis situation. During crisis communication, leaders are required to frame ‘meaning’ of the crisis in order to shape how public perceives the risks, consequences and how they respond to the measures being taken. Developing a persuasive narrative in communication is thus integral to succesful framing of the crisis and for a strategic leadership. The construction of a successful persuasive narrative requires five frame functions: namely that the narrative will offer a credible explanation of what happened, it will provide guidance, instil hope, show empathy, and suggest that leaders are in control (Boin et al., 2016 ). In doing so, leaders aid the public’s understanding of the facts associated with crisis while sumltaneously acknolwedging and appealing to collective emotions. In incorporating these frame functions, leaders are posed with various choices and decision-making such as how they choose to or not choose to dramatise the situation, the language that they use and how they appeal to the colleactive emotions and stress.

As digital media technologies became popular resources for getting and spreading information, public officials and leaders also increasingly started using them as domains during the crises. In fact, for some scholars the use of social media while enabling mutual interaction between the leaders and recipients has altered the field of crisis communication altogether. For instance, it was found that as social media enables constant and effective communication, it was used more regularly than traditional media outlets during crisis (Kim and Liu, 2012 ). Similarly, Utz et al. ( 2013 ) discussed how for effective crisis communication strategy, the use of media channels, social media—Twitter, and Facebook—versus traditional— newspapers—was more critical than the type of the crisis. Moreover, Schultz et al. ( 2011 ) concluded that when compared to traditional media networks, crisis communication received less negative response when social media was used. Hence, it is not to our surprise that public officials nowadays are turning to social media platforms for communicating with the masses during crisis. They not only use these tools to communicate about crisis but also request information from the public. This was the case during the COVID-19 pandemic crisis where social media was employed by political leaders across the globe to mediate the communication of information about the pandemic as well as for reaching out to their citizens. This paper by focusing on the Norwegian case and more specifically on the Norwegian Prime Minister’s Facebook use during the time of COVID-19 pandemic aims to explore the use of social media platforms by political leaders during crisis. Our goal is to better understand how political leaders adapt social media technologies in their communication strategies during crises.

Our data that covers Erna Solberg’s Facebook posts between February 27, 2020, and February 10, 2021 (a total of 271 posts) were extracted from Footnote 2 into an Excel sheet. A total of 114 posts were removed as they were not related to COVID-19 leaving us 157 posts for further analysis. To aid the coding process, we noted the variables presented in Table 1 . These are: date, number of interactions, number, and type of reactions (e.g., angry, sad, like, etc.), URLs of links shared, and a description of the content of the posts that was later used in the qualitative analysis. We also noted if the posts were made during any particularly critical period (e.g., before, during or after new restrictive measures were introduced). The content of the posts and the number of likes and other reactions derived from this data should be considered a ‘snapshot’ of Solberg’s posts as they appeared at the time of data collection (Brügger, 2013 ), as it is possible that some posts have been subsequently removed, or that the numbers and types of reactions to the posts have changed by the publication date

The data was analysed through thematic analysis (Braun and Clarke, 2006 ): in the first step, we read all posts and generated the first set of codes. Next, we combined all the similar codes while labelling them in clusters and organised them into analytical themes/categories (see Fig. 1 ). The authors then discussed and reviewed these analytical themes and merged them into aggregate/conceptual themes. Lastly, we reviewed the aggregate themes through the lens of the five frame functions of persuasive narrative and identified commonalities and differences. We have included some posts under each theme to illustrate our analytical process and illuminate the themes (Sandelowski, 1994 ). All posts presented here were translated from Norwegian to English by the authors.

Schematic formulation of a theme from the categories captured in posts.

Our analysis resulted in five themes: (1) Promoting responsibility and togetherness (2) Coping (3) Being in control amidst uncertainty (4) Fostering hope and (5) Relating with the followers. In reviewing our findings from the framework of Boin et al. ( 2016 ), we found that all five frame functions of persuasive narrative were embedded in Solberg’s posts and aligned with our themes. Below we discuss our themes with reference to frame functions of Boin et al. ( 2016 ) for a persuasive narrative and in doing so, add contextual nuances to each theme.

Promoting responsibility and togetherness: we are in this together

Analysis of Solberg’s posts revealed a strong message of responsibility and togetherness. In almost all shares, she not only emphasized solidarity but also called for courage and responsibility. This Facebook post, shared soon after comprehensive shut-down measures were introduced, shows how important, for Solberg, was Norwegian solidarity expressed as ‘we’ (March 12, 2020):

Dear everyone. In times of crisis, we understand how dependent we are on each other. What unites us is more important than what separates us. This is not the time for ‘I’. This is the time for ‘we’.

Lunn et al. ( 2020 ) note that citizens are isolated during government induced or self-imposed quarantines: appeals to collective action and a spirit of ‘we-are-in-it-together’ are important ways to ensure compliance with quarantine and hence curb the rate of infection. Leaders in countries such New Zealand, UK, Brazil have also been found to have used a similar narrative emphasizing patriotic duty, love of country, and coming together as one, to mobilise community action (Dada et al., 2021 ).

Her posts were also imbued with appreciation and expression of gratitude towards healthcare workers and those who follow rules. For example, after introduction of the ban to travel to cabins and after the government’s decision to extend regulations until after Easter, Solberg posted the following on April 4, 2020, receiving a high number of likes:

I feel proud when I see how we handle this together. Many thanks to everyone who follows the advice from the health authorities. Many thanks to everyone in the health service who works hard and perseveres. Many thanks to all Norwegians for the patience, love and solidarity we now show each other

The use of the word ‘I’ and how it was being used in reference to ‘feel[ing] proud’, we argue, highlights the ‘positioning of self’ by Solberg. Davies and Harré ( 1990 ) claim that development of the notion of ‘positioning’ is a contribution to the understanding of personhood, and how speakers choose to position their personal identity vis-a-vis their discontinuous personal diversity (such as being the Prime Minister, politician, Norwegian citizen, etc.). In such posts, whether intentionally or unintentionally, we also see the discursive practices through which Solberg allocates meaning to her position as a Prime Minister by emphasising that she feels proud upon seeing those who follow advice. At the same time, her emphasis on ‘we’, as in how ‘ we handle this together’, places her as a member of the Norwegian masses.

Moreover, such references to togetherness and solidarity also reflect attempts to utilise the existing nationalistic cultural repertoire of the Norwegian concept of dugnad . For example, on New Year’s Day following the Gjerdrum community disaster (a sudden and unexpected mudslide that destroyed several residential houses) and rise in the number of infections during the holiday period (2125 reported cases on December 29, 2020), Solberg posted the following post:

[…] During the year we have put behind us, Norway has lined up for the big dugnad . People have put their interests and dreams on hold to protect the elderly and the risk groups. It has saved lives. I am deeply grateful, proud and touched, for the way the Norwegian people have handled the biggest challenge for our society since World War II. We lined up for each other when it mattered most…

Dugnad in Norwegian is voluntary work that is performed as a collective effort (Moss and Sandbakken, 2021 ). Nilsen and Skarpenes ( 2020 ) discuss how the concept of dugnad is embedded in a moral repertoire of the socially responsible citizen that is indicative of a specifically Norwegian welfare mentality and conclude that dugnad is imperative for the sustainability and resilience of the Norwegian welfare model. Before the pandemic, Simon and Mobekk ( 2019 ) argued that the concept of dugnad is central to Norwegian culture, inculcating prosocial and cooperative behaviour, and thereby plays a role in Norway being one of the most egalitarian democracies and having high levels of equality and reciprocity. In the context of COVID-19, social anthropologist Thomas Hylland Eriksen ( 2020 ) pointed out that one reason for the success of the Norwegian approach was the mobilisation of broader society to fight COVID-19, driven by the notion of dugnad . Similarly, Moss and Sandbakken ( 2021 ) analysed data from press conferences and interviews with members of the public and found that many participants mentioned liking how the government talked of ‘a spirit of dugnad ’ ( dugnadsånd ), appealing to shared voluntary work rather than strict rules. The authors posit that in a pandemic it is crucial to create and use meta-narratives that are a good fit with the context in order to aid meaning-making and increase compliance. The use of dugnad as a cultural repertoire has, however, met with criticism from some scholars, who argue that ‘a word associated with solidarity, unity, and voluntary work obscures the forced nature of the measures’ (Tjora, 2020 ) and shifts the onus for finding solutions onto individual citizens or groups (Nilsen and Skarpenes, 2020 ; Hungnes, 2016 ).

Despite the criticism of imbibing such cultural repertoire, the alignment of the key values of Norwegian society with the core message of encouraging collective action is essential for a crisis narrative to be politically effective (Boin et al., 2016 ). Furthermore, the theme of ‘Promoting responsibility and togetherness’ shows the context specific nature of crisis communication narrative in the case of COVID-19 in Norway and therefore adds to the components for a persuasive narrative.

Coping: everything will be fine

Solberg’s Footnote 3 posts also carried messages that address the consequences of coping with COVID-19, namely self-isolation, and loneliness. For instance, her posts guided followers in dealing with loneliness and maintaining general physical and mental health. The Norwegian government, like that of many other countries, had introduced measures such as mandatory quarantine and social distancing rules to manage the spread of the virus. Studies have shown that home confinement during COVID-19 has negatively affected the emotional state of individuals due to depression and anxiety and has led to or increased a sedentary lifestyle (Sang et al., 2020 ). Thus, emphasis on the well-being of the population during COVID-19 is important for effective crisis management (WHO, 2020a ) because increased well-being would reinforce its coping abilities during illness and hardships. As these are not the direct effects of the COVID-19 infection, but a result of the contagion containment measures imposed on citizens by the government, we observe Solberg taking responsibility and providing solutions to help. In doing so, she appears sensitive and caring towards the public.

Christensen and Lægreid ( 2020 ) attribute the ‘high-performing’ handling of the pandemic in Norway to the initial focus on suppression, followed by a control strategy. The authors further examine the ideas that having successful communication with the public, a collaborative and pragmatic decision-making style, the country’s resourcefulness, and high trust of government all contributed to the relative success in Norway. Adopting the correct and effective strategy indeed heavily influences the outcomes of crises. However, to fill the ‘cognitive void’ that the public might be experiencing, leaders need to manage the meaning-making process and ensure legitimacy of their actions (Boin et al., 2016 ). Solberg and the other ministers played an important role in communicating with citizens and the media through daily media briefings together with the NDH (Norwegian Directorate of Health) and NIPH (Norwegian Institute of Public Health) (Christensen and Lægreid, 2020 )

Solberg emphasized the impact of loneliness, for example, during one of the first holiday periods during the pandemic when comprehensive shut-down measures were introduced, she wrote:

Many people may feel lonely during holidays such as Easter, and the corona crisis exacerbates this. Therefore, I would like to encourage everyone to call someone you know is alone at Easter. The little things can mean a lot. Happy Easter!

A study by Blix et al. ( 2021 ) on the topic of mental health in the Norwegian population during the COVID-19 pandemic found that a substantial proportion of the population experienced significant psychological distress in the early phases. More than one out of four reported ongoing psychological distress over the threshold for clinically significant symptoms. Two other categories of individuals (those recently exposed to violence and those with pre-existing mental health problems) were found to be at special risk but worrying about the consequences of the pandemic was also found to contribute negatively to mental health. In this regard, Shah et al. ( 2020 ) argued that several nations have failed to address the mental health aspect among the public, as far more effort is being focused on understanding the epidemiology, clinical features, transmission patterns, and management of COVID-19. Solberg’s open discussion about mental health during the pandemic implies a situation-specific and data-driven strategy of managing the less visible effects of the pandemic and show insight in anticipating future needs (Han et al., 2020 ).

Moreover, Solberg’s posts also subtly utilised the Norwegian concept of friluftsliv , which translates as ‘free air life,’ a philosophy of outdoor living and connection with nature (Henderson and Vikander 2007 ). Friluftsliv is associated with grand narratives of Norwegian national identity depicting outdoor adventures, foraging, and a deep connection to nature (Jørgensen-Vittersø, 2021 ). For example, with the re-opening of DNT [Den Norske Turistforening] cabins in mid-2020, Solberg in her post on June 11 emphasized the importance of being outdoors in fresh air:

We need to use our bodies and get out into the light and fresh air. It is important for both physical and mental health! I hope many have a good and active Norwegian holiday this year!

In these posts, Solberg also shared pictures of herself being outdoors. In such ways, Solberg appeared to be offering not only guidance for coping with the challenges and consequences of living during the pandemic, but also emphasizing one characteristic of the Norwegian culture, which they are proud of—spending time in nature. Be it advice to spend time in nature, or to keep social distance or self-isolation, we consider that Solberg’s approach to coping aligns with the frame function of ‘offering guidance’. During a crisis, leaders have a window of opportunity during which they can communicate a frame to not only make sense of the crisis but also to provide guidance and to portray themselves as attentive and concerned about the challenging circumstances faced by the public (Boin et al., 2016 ). By depicting herself as attuned to the emotions experienced by her followers during the pandemic and by utilising the moment to suggest ways of coping, Solberg’s communication encapsulates the frame function of offering guidance for a persuasive narrative.

Being in control amidst uncertainty

In her posts, Solberg presented a narrative of being in control amidst uncertainty, which aligns with two of the frame functions of Boin et al. ( 2016 ), namely offering a credible explanation and suggesting that leaders are in control. In times of a crisis, it is important that leaders do not downplay the gravity of the situation or claim unrealistically optimistic scenarios (Boin et al., 2016 ). We see that Solberg maintained a balance by providing a detailed explanation of her actions and the reasons behind the restrictive measures taken. At the same time, she acknowledged the uncertainty inherent in the ever-changing crisis and demonstrated her concern. According to Lunn et al. ( 2020 ), in situations characterised by uncertainty and fear, responsible leaders need to signal that they are in control of the situation, which can be demonstrated by making decisions with confidence and honesty. Moreover, it is also essential that leaders do not make promises that are impossible or unrealistic, because doing that can impede the persuasiveness of their narrative by affecting their credibility later (Boin et al., 2016 ). In Solberg’s posts, we see that she displays confidence but also the reality of uncertainty and concern, which is a sign of effective leadership and shows ‘bounded optimism’ (Brassey and Kruyt, 2020 ). The following post where she writes about her worries and concerns followed by advice is a good example of credibility and control:

I am worried. Right now, we have ongoing outbreaks in Bergen, Oslo, Trondheim and Hammerfest… We know that vigorous work is being done intensively in these municipalities with infection detection and other measures. Although Norway has relatively low infection rates, we also register here at home that the number of hospital admissions and the number of infected have increased recently. We now have the highest number of hospitalized patients with COVID-19 since May… We also see that the infection has begun to spread to older age groups. And there is a significant risk that the numbers will continue to rise as we see in Europe. That is why we have today announced new national austerity measures next week. We can still reverse the trend here at home…

A demonstration of concern from role models has been shown to have a role in persuading the public to adhere to recommendations (Simon and Mobekk, 2019 ). Tannenbaum et al. ( 2015 ) note that fear is easier to handle when it is acknowledged, which relates to the idea of ‘citizens being anxious enough to take the advice from the authorities to heart and optimistic enough as to feel that their actions make a difference’ (Petersen, 2020 ). Inculcating ‘optimistic anxiety’ (Tannenbaum et al., 2015 ) is therefore an important feature of crisis communication narratives.

Another important nuance that emerges from Solberg’s posts is her comparisons to other countries to draw attention to the seriousness of the situation. For example, on November 5, 2020, Solberg made the following post announcing new national measures, which received over 5000 likes:

My message to the Norwegian people is: Stay at home as much as possible. Have the least possible social contact with others. It is absolutely necessary to avoid a new shutdown. Norway is at the beginning of the second wave of infection… The virus is spreading rapidly and all counties now have outbreaks. The government is therefore introducing new national infection control measures… If the current rate of infection continues, the number of inpatients in intensive care units will increase sharply in the coming weeks. This will lead to less intensive capacity for other seriously ill people. We are now where the Netherlands was at the beginning of September. A very rapid increase in infection in the Netherlands quickly led to more patients in the intensive care unit… Other European countries have similar experiences. There is therefore a heavy seriousness about the situation. And we must take responsibility together

By giving detailed reasoning behind measures being taken amidst uncertainty, Solberg exhibits both confidence and honesty in her narratives (Lunn et al., 2020 ). Another key feature that emerges from the post above is the emphasis on the risks of an increase in infection, and the possibility of a new lockdown and overburdening of intensive care capacity, thereby reflecting a more strongly persuasive intent. Such emphasis on the risks is different from other posts where Solberg exhibits control and optimism much more strongly. This adaption from a communicative stance to a more persuasive one could result from not only the perceived severity of the situation, but also the perceived risks of pandemic fatigue. Pandemic fatigue has been defined by the WHO as a lack of motivation to adhere to recommended protective behaviours (WHO, 2020b ). According to surveys conducted in different countries, most people have been shown to possess adequate knowledge of COVID-19 and the precautions required to keep safe, yet factors like emotions and context have been found to have greater impact on behaviours than knowledge (Gavi the Vaccine Alliance, 2020 ). A study of different ways of communicating healthcare messages suggested that believability of the messages and the recipients’ reactions to them can be influenced by the persuasive intent (Wang and Shen, 2019 ). Koh et al. ( 2020 ) also discuss the importance of devising effective and successful communications for a sustained period without message fatigue setting in, which includes concern for the way the communication is framed. Overall, we see that Solberg’s posts provide a rationale with portrayal of the government being in control of managing the crisis.

Fostering hope and return to normalcy

Solberg’s posts also emphasized the hopeful aspects of the crisis by appealing to followers to look forward to a return to everyday life, and new educational and economic prospects, despite the difficult current circumstances. This theme aligns with the frame of ‘instilling hope’ as per frame functions for a persuasive narrative by Boin et al. ( 2016 ). During a crisis, more than ever, effective leaders embody the hopes and fears of the society under threat, and therefore they should strive to inculcate optimism of a better future (Boin et al., 2016 ). Previous research has documented that in times of turmoil, followers especially look up to leadership that serves as a beacon of hope for and faith in a positive future, more than they do in times of prosperity (Stam et al., 2018 ; Shamir et al., 1993 ). According to Boin et al., leadership during crisis always has a moral dimension. On January 10, 2021, by which time Norway had witnessed over 50000 cases of infection and over 400 deaths as well as the Gjerdrum disaster, Solberg made the following post:

Dear everyone. This year I hope we can take our dreams back. After a year of pandemic and fear. Then I look forward to seeing creativity unleashed…

Another post that emphasized the optimism for educational prospects was made on April 15, 2020, and drew over 5000 likes:

Today is the last deadline to apply to a vocational school, college or university. I understand that it can feel strange to apply for an education this autumn while the educational institutions keep their campuses closed. Maybe someone also thinks the idea of moving from home to a new city seems extra scary these days. To you I want to say that everyday life will return. Therefore, my appeal to you who want to study: do not put your life on hold, but apply for education this year!

Lessons from previous crises tell us that leaders need to pay attention to the fear of the ongoing threat, as well as sadness and grief, and to provide hope to mitigate social disruption (Maak et al., 2021 ). Here, we see that Solberg’s is attempting to convey hope while also acknowledging the challenges and impact of COVID-19. In doing so, the messages also emphasise self-efficacy and trust in the government. Hope and resilience are closely aligned constructs, as they both include a tendency towards maintaining an optimistic outlook in the face of adversity (Duggal et al., 2016 ). Thus, fostering hope during crisis can help the community cope with the consequences of the crisis. Moreover, by using emotional appeals, leaders can influence attitudes and behaviours as well as induce compassion (Ghio et al., 2020 ).

The theme of fostering hope in Solberg’s posts was found to be particularly emphasized during and before national holidays or important events. Her posts often utilised humour to foster positivity, particularly during critical periods such as during or after implementation of stricter COVID-19 measures. For example, a day after it was announced that infection-reduction measures would continue throughout Christmas, Solberg shared a snipped of her response to a question asked in a press conference and posted:

Can Santa actually come to visit this year?

Creating human moments and hope is a sign of compassionate leadership and helps to establish the relational foundation for widespread support for pandemic control measures (Maak et al., 2021 ). Also, by utilising humour, Solberg adapts the tone of her messages, a tactic that has been found to significantly affect audiences’ attitudes and behaviours, help people manage their emotions, and strengthen support for pandemic measures (Lee and Basnyat, 2013 )

Relating with followers

The last theme is about the posts in which Solberg relates to the public by providing personal information, acknowledging, and relating with the difficult circumstances, and using humour or a private tone in her posts. For example, the post below was made just before Easter and it received more than 13000 likes, making it to be the third-most liked post of Solberg related to COVID-19 during this period.

It will be a different Easter this year. Let’s make the best of it. We can play fun board games with our loved ones, read the book we never have time to read, listen to an audiobook or explore the local area. The last few weeks have been challenging for all of us, but we want to get through this… Sindre and I have recharged with board games and wish you all a very happy Easter!

Empathy is an important component of the persuasive narrative, especially during crises when the decisions made by authorities to mitigate, and control can also have consequences for people’s lives. For crisis communication to be effective, the information provided to the public should not be too factual or portray leaders as distant from the citizens (Shen, 2010 ; Lunn et al., 2020 ). By demonstrating concern and acknowledging the impact of crises, leaders can empathise with the public (Shen, 2010 ; Lunn et al., 2020 ). We see Solberg personifying the challenges of COVID-19 by referring to how the times have been challenging for ‘all of us’. According to Boin et al. ( 2016 ), a leader’s personification of suffering is instrumental in showing empathy because the public is then able to relate to them.

Further, previously in a study by Larsson ( 2015 ) about Norwegian party leaders on Facebook during the 2013 ‘short campaign’, it was found that personal content referencing private life is increasingly employed by Norwegian party leaders. Enli and Rosenberg ( 2018 ) investigated voters’ evaluations of politicians as authentic or ‘real,’ and Solberg was found to be one of the most perceived authentic politicians. Enli ( 2014 ) had earlier suggested that Erna Solberg’s public profile as predictable, anti-elitist and imperfect constructs her authenticity.

A similar example of relatability with followers during the pandemic was the instance when she forgot the rule of not shaking hands during public meetups and press conferences. After the event, she wrote:

It is important that we can have some humour in a difficult time Even a prime minister can forget, but now it is important that we all remember to follow the advice of the health authorities…

She also used an engaging communicative style when interacting with her followers:

Then the holiday is over… a different summer, a little cold, weekly meetings in the Government’s Corona Committee on video, beautiful nature experiences from Norway and a lot of rain. Let me share a wonderful little meeting with a lynx on the lawn on Varaldsøy… Have you had a nice summer?

Thus, Solberg embeds references to her private life, which also helps to personify the messages in her posts and thus relate with the public. In addition, by relating with the public on an everyday basis and through the acknowledgment of shared challenges during crisis, Solberg’s narrative also appears empathetic. Our theme of ‘Relating to the public’ thus encapsulates frame function of ‘showing empathy’ for developing a persuasive narrative, as per Boin et al. ( 2016 ).

Concluding remarks

This paper was an attempt to explore the Facebook posts of Norway’s Prime Minister Erna Solberg to highlight the key features of her crisis communication during the COVID-19 pandemic. By drawing on data from Solberg’s Facebook posts during the pandemic our analyses identified five major themes, (1) Promoting responsibility and togetherness (2) Coping (3) Being in control amidst uncertainty (4) Fostering hope and (5) Relating with the followers, where we went in detail explanation by using frame functions of a persuasive narrative by Boin et al. ( 2016 ). We furthermore discussed the specific Norwegian contextual nuances to the frame functions. These were the theme ‘Responsibilization and togetherness’, presented via the references to Norwegianness and the cultural concept and practice of dugnad . Hence, our paper showed how during crisis persuasive narratives are incorporated into the social media communication strategies of political leaders.

The paper also showed how persuasive narratives are delivered through praising the public’s efforts, promoting togetherness, caring about the public’s well-being, displaying optimism and confidence in the government’s measures. It elaborated on how crisis management on social media was done via the use of humour and personal information. Humour was used as a tool to engage with the public and help them relate and comply to the COVID-19 restrictions. Hence, Solberg used Facebook to capitalise on a wide-reaching social medium (Hallahan, 2010 ). While the communication of leaders during crises helps to fill the cognitive void, the use of social media helps build societal resilience by improving awareness and encouraging preparedness (Boin et al., 2016 )

Even so, the success of a persuasive narrative is to a great extent dependant on the credibility of its proponents (Boin et al., 2016 ). The reputation of the leader and the organisation that they represent plays a key role in framing a successful persuasive narrative. In general, Norwegians have more trust in each other and their institutions than most other countries (Skirbekk and Grimen, 2012 ). A survey conducted by the Norwegian Citizen’s Panel [Norsk Medborgerpanel] in March 2020 found that trust in government, in the health authorities, in parliament, and in national and local politicians had increased, as did trust in the Prime Minister during the pandemic (Dahl, 2020 ). Clearly, Solberg seems to have benefitted from the trust capital in Norwegian society with her Facebook communications during a crisis. More recently, Erna Solberg has received heavy criticism for breach of COVID-19 restrictions during a family trip to Geilo for her 60th birthday (The Guardian, 2021a ). Following which, Erna Solberg, has been investigated by police and fined (The Guardian, 2021b ). Thus, while her Facebook posts exhibiting components of a persuasive narrative received popularity, her actions have nevertheless been subjected to scrutiny and criticisms in mainstream media (Larsen, 2021 ). According to Boin et al. ( 2016 : p. 72), the retainment of confidence of the public is essential for the communication strategies to be effective. Therefore, such media criticism might undermine the credibility of Solberg and her cabinet, leading to less credible and politically ineffective narratives. On the other hand, past performances, and reputation also play an important role in increasing leaders’ personal credibility in the face of crisis (Boin et al., 2016 ). Consequently, Solberg’s long career in politics and her reputation of caring about the citizens as previously discussed, could buffer the recent impact on her credibility. Moreover, communication during and after a crisis affects long-term impressions (Coombs, 2007 ). With the personification of politics in Norway or ‘decentralising personalization’ (Balmas et al., 2014 ), the criticisms paved at Erna, however, reflect more of a personal crisis than a national crisis. And while we do not analyse Solberg’s posts beyond 9 th Feb. 2021 i.e., after Solberg spoke about the Geilo trip incident on her Facebook account, we see that she follows similar strategy in handling this personal crisis as the national crisis of COVID-19, through use of a persuasive narrative. Future studies can therefore focus on how Solberg and other political leaders utilise the strategy of persuasive narrative in management of personal crisis in nexus with national crisis such as that of COVID-19.

Further, we concur with Christensen and Lægreid ( 2020 ) who write that the ‘political leadership has succeeded well in connecting governance capacity and legitimacy using the argument that Norway had sufficient resources to deal with the crisis. While the health resource capacity and preparedness of Norway inarguably contributes to the outcomes of the crisis, communicating a successful persuasive narrative with credibility is integral to gaining legitimacy and filling the cognitive void (Boin et al., 2016 ). Erna Solberg’s use of persuasive narrative in Facebook posts, seems therefore to have been effective in the management of the COVID-19 pandemic, but her latest unfortunate incident goes to show how politicians’ management of crises is tenuous and highly dependent on public trust.

Our study adds to the significance and knowledge of how persuasive narratives are incorporated into the communication strategy of leaders on a social media platform and highlights the usefulness of this framework for studies about ongoing and future crises. By using data from social media, our findings also add to the understanding of the increased personification of politics and how leaders utilise this personification to communicate government measures and engage with the public during a crisis. Future research can further explore how public leaders and health authorities’ frame crises situations, actions, issues, and responsibility to dramatise and reinforce key ideas (Hallahan, 1999 ). Such insights can pave way for understanding public’s shaping of risk perceptions and compliance to behavioural measures during crises such as the COVID-19 pandemic.

Data availability

The dataset analysed during the current study is available through the public profile of Erna Solberg on Facebook: https://www.facebook.com/ernasolberg/ . This dataset was derived from Crowd Tangle which can be accessed through request at https://www.crowdtangle.com/ .

Known as ‘hyttetur’, cabin trips are deeply rooted in Norwegian culture and way of life

Crowdtangle extracts both historical and current data of post contents and metadata such as the date the post was made, number of likes, other reactions and shares. Information about how to access raw material included in this study can be found in the data availability statement at the end of the article.

‘Everything will be fine’ [ Alt blir bra ] was one of the campaigns that spread because of the COVID-19 crisis in Norway depicting pictures of a rainbow.

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This article is published as part of the research project ‘Fighting Pandemics with Enhanced Risk Communication: Messages, Compliance and Vulnerability During the COVID-19 Outbreak (PAN-FIGHT)’, which is financed by the Norwegian Research Council (Project number: 312767).

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Arora, S., Debesay, J. & Eslen-Ziya, H. Persuasive narrative during the COVID-19 pandemic: Norwegian Prime Minister Erna Solberg’s posts on Facebook. Humanit Soc Sci Commun 9 , 35 (2022). https://doi.org/10.1057/s41599-022-01051-5

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The Science of Persuasion Offers Lessons for COVID-19 Prevention

Hand washing, mask wearing, social distancing—experts agree these protective behaviors are key to stemming coronavirus disease 2019 (COVID-19). But how should leaders encourage their uptake?

Look to the science of persuasion, says communications professor Dominique Brossard, PhD. Brossard is part of a new National Academies of Science, Engineering, and Medicine group called the Societal Experts Action Network, or SEAN, whose recent report lays out research-based strategies to encourage COVID-19–mitigating behaviors.

Brossard says the changes must feel easy to do—and to repeat, which helps to form habits. Past public health campaigns also suggest it’s wise to know and understand one’s target audience, and to tailor messages and messengers accordingly.

“It’s difficult to change people’s behavior at the massive level,” Brossard, chair of the life sciences communications department at the University of Wisconsin-Madison, said in a recent interview with JAMA. The following is an edited version of that conversation.

JAMA: You and your coauthors write that simply explaining the science of COVID-19 and its risks will rarely translate to a change in attitudes and behaviors, even if people understand and accept the facts. Why isn’t it enough to explain the science if you want to change health behaviors?

Dr Brossard: Because human beings rely more on the psychological dimensions of the risk than the quantitative aspect of the risk. If experts measure risk in numbers, such as the probability of getting harmed by something, human beings in general—you and me included—look at what we call the qualitative aspect of that risk: the potential magnitude of the effect, the potential dread, how much it may impact people [close] to us, and so on. So, psychological dimensions.

JAMA: How does that translate to people’s unwillingness to change their attitudes and behaviors?

Dr Brossard: If we’re asked to do something new, that will impact our willingness to do it for a variety of reasons. It might be because people around us, our social network, the norms around us tell us that this is something that’s not acceptable. It might be because it’s a little inconvenient. It might be because we forget about it. At the end of the day, when we perform certain behaviors, rarely do we think about the science that tells us why we shouldn’t do it and why this might be dangerous. We do it because, as social animals, we pay attention to cues that our minds tell us to pay attention to and our community and people around us tell us to pay attention to. Therefore, our behavior is really based on the psychological components rather than more quantifiable aspects.

JAMA: Your report recommends 5 habit-promoting strategies: make the behavior easy to start and repeat; make the behavior rewarding to repeat; tie the behavior to an existing habit; alert people to behaviors that conflict with existing habits and provide alternative behaviors; and provide specific descriptions of desired behaviors. How can these strategies be applied today?

Dr Brossard: People are more likely to act in healthy ways when it’s easy for them to perform that behavior. So let’s think in terms of hand washing, for example. It will be very important to have hand washing stations and hand sanitizer easily accessible to people. Making the behavior very easy to start and to repeat is very important. If you put a mask next to your front door, and it’s easy to grab when you go out the door, that’s going to be easy to implement and you may be more likely to actually do it again. If you want to encourage people to physically distance from other people around them, having signs on the floor is actually something that works. They don’t have to calculate in their mind: what does it mean to be physically distanced? How far am I from other people? They simply stand where the mark tells them. It makes the behavior easy to repeat and easy to perform.

JAMA: So you’re trying to take away any barriers to the behaviors?

Dr Brossard: Exactly. The idea is if you take away as many barriers as possible, you encourage people to repeat the behavior. And then you end up creating a habit.

JAMA: In your report you mentioned that having many hand sanitizer stations sets the norm—that it’s normal to hand sanitize.

Dr Brossard: Mask wearing and physically distancing are new habits we’re creating from scratch. As social animals, that’s not something we do, in general. However, hand washing is a habit that we would have hoped the population already had. The problem is it hasn’t been really implemented. People do it very inconsistently. If you have hand sanitizers everywhere, it’s very easy. As a matter of fact, in supermarkets, when you have the hand sanitizer at the door, people line up and do it. So it’s that idea of the social norm and making it sound like, this is something you do, it’s widely available, other people do it as well, and therefore, this is socially acceptable and highly encouraged, and we should just all do it.

JAMA: The report also discusses 10 strategies for communicating risk, like using clear, consistent, and transparent messaging. It feels like that’s the opposite of what we’ve had. What’s your take on the federal government’s messaging around COVID-19 mitigation?

Dr Brossard: I think that in this case what’s really crucial is the messaging at the local level. At the state level vs county level vs town level, having a consistent strategy, consistent messages, is very important. It’s clear that for public health–related issues, really what makes a difference is the action of local leaders. It’s really the community-based action that can change people’s behavior. At the local level people trust the doctors, the public health officials.

JAMA: Masks unfortunately have become politicized. Is it too late for universal masking to be accepted or do you think minds can still be changed?

Dr Brossard: You will always have extremes on both ends. The vast majority of the population will be somewhere in between. People that are extremely set on the attitude not to wear a mask, which is, by the way, a very, very small minority, are unlikely to change their views. However, all the others can change their views. People are reasonable in the sense that they want to protect their own, they want to protect the community, they want to have the economy reopen, and so on. So I would say, yes, there’s still hope. And we see it. Every week, our group at the SEAN Network publishes a summary of all the polls that address [COVID-19–related] behaviors. We see that mask wearing is increasing. It’s not yet at the level that we would like to make sure that we are protected, but it’s indeed increasing.

JAMA: You reported that highlighting crowded beaches or people who aren’t wearing masks can be counterproductive. Why? And what’s a better approach?

Dr Brossard: They end up thinking that it’s a more prevalent behavior than it actually is. Or it may actually prompt them to think, “Oh, I wish I was on the beach.” You want to highlight good behavior and make it sound like this is socially acceptable rather than highlighting undesirable behavior and making it sound like it’s more frequent than it actually is.

JAMA: So local leaders should emphasize that mask wearing is increasing, for example?

Dr Brossard: Exactly. The research on social norms is extremely, extremely important here. We tend to get cues based on the people around us. Human beings have something that we call fear of isolation. We don’t like to be the lonely person that is the only one doing a certain thing when the vast majority around us are doing another thing. So it’s very important to actually show, “Look, this is going in this direction. Political leaders from both sides of the spectrum are doing it.” To show that the desirable behavior is something that’s becoming prevalent and that this is the direction society is taking.

JAMA: One lesson in your report is that it’s important to concede uncertainty. Why should leaders say things like, “Based on what we know today…”?

Dr Brossard: This is a really key message of risk communication. If you highlight something as being certain and then the science changes and suddenly you say, “Well, wait a minute, actually this was wrong, and now it is this,” you destroy trust. Science evolves, particularly in the context of COVID-19. We are all discovering this virus. The social sciences have shown that acknowledging uncertainty will actually increase trust, much more than painting things as certain. So it’s very important to say, “Based on the science of today, this is what we should do.” It’s very important to show that it’s a work in progress.

JAMA: What about the messengers themselves? Have we tapped into social media influencers enough? And who are community influencers that have the power to change our collective behaviors?

Dr Brossard: It makes us think of the AIDS community, where the leaders of the communities were messengers in helping promote protective behaviors. Using messengers that are trusted by the target audiences and relying on social media is extremely important. And as far as influencers in the communities, this will depend from one community to the other. Let’s take Wisconsin, for example. Football is a sport that people enjoy regardless of their political ideology, age, and so on. So the [Green Bay] Packers are messengers that transcend potential barriers there. It’s important to find trusted messengers that can connect with the audience on social media but also face-to-face. That can be a trusted local business leader, for example.

JAMA: What have we learned from past public health campaigns, like antismoking and wearing seatbelts, that can be applied now?

Dr Brossard: In the ’70s, we had social marketing approaches that suggested that we needed to stop trying to educate people and actually adapt a marketing technique to social issues. The antismoking Truth campaign, as it was called, was a successful application of social marketing techniques. The idea that you need to segment your audience and tailor the message specifically to that audience is something that the Truth campaign very well illustrated. A specific audience that needed to be targeted was adolescents and teenagers, and one thing that adolescents do is rebel against authority. They don’t like people to force them to do things. So the Truth campaign tried to appeal to their drive for autonomy by showing them that the tobacco industry was taking advantage of the adolescent population. That was extremely powerful. The problem is that a mass media campaign like that can be extremely, extremely expensive. That’s why it’s very important also to rely on what we think of as organic dissemination of messaging through social media, which we couldn’t do when the Truth campaign was put together.

JAMA: How can physicians apply these strategies of persuasion with patients, in their communities, or on social networks?

Dr Brossard: We are all tempted to correct misinformation. And right now, we see it everywhere, right? However, we need to be careful because by repeating the misinformation itself, we make it more prevalent. When physicians want to communicate about COVID-19, it’s better to actually communicate the right information without repeating the misinformation itself. I think it’s very important to remember that all of us are part of the solution by making sure that those right behaviors get communicated to as many people as we can. I think physicians have a really, really big part to play in this organic dissemination.

JAMA: How will these strategies apply once we have a COVID-19 vaccine?

Dr Brossard: It goes back to that idea of targeting and audience segmentation to understand who has issues with the vaccine—in this case potentially COVID-19—and why. We actually do not know why people think the way they do. What we do know is that there’s no wrong concern. If people are concerned, they’re concerned. We need to listen and try to understand why and then address that.

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Abbasi J. The Science of Persuasion Offers Lessons for COVID-19 Prevention. JAMA. 2020;324(13):1271–1272. doi:10.1001/jama.2020.15139

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Coronavirus Disease 2019

The coronavirus speech i’d give, realistic reasons for hope..

Posted March 21, 2020 | Reviewed by Jessica Schrader

Updated: Apr. 24, 2020

The media’s core message on the coronavirus is that even if we behave, coronavirus will change life as we know it for years to come: massive job loss, disease, and yes, death, rivaling the Spanish Flu, which killed 50 to 100 million people.

Perhaps a perspective from someone with little to gain from sensationalism nor from political blaming might replace some of the fear with realistic hope.

There are at least three reasons for realistic hope that the coronavirus problem will be satisfactorily addressed than is feared:

1. A simpler, faster test is here: Abbott Laboratories have developed a COVID-19 test that produces the results in five minutes, onsite, and the FDA has just authorized the first at-home swab test.

2. As of April 6, there were more than 200 coronavirus vaccines and treatments in development. It would seem that with some of the world's greatest minds working tirelessly, one will be developed, again, sooner than later. The WHO says that an effective treatment is likely just weeks or months away.

3. Social distancing works and in the U.S. compliance has risen to over 90 percent as of April 15, and since then, subjectively, I've noted ever greater compliance.

So live your life. Sure, practice social distancing, wear a mask in stores, and wash your hands often, but also take advantage of the slowed economy to do things you had wished you had time to do: Speak with friends, do a hobby, do volunteer work by phone or on the internet. Upgrade your skills and networking connections so when the economy and job market improves, you'll be ready. Love more.

Society will survive the coronavirus pandemic, not just because of improved preparedness for an epidemic but because we’ll live with a greater sense of perspective and appreciation of life’s small pleasures: from that first bite of food to the beauty of your loved ones to more present conversations with friends and family. Don’t let coronavirus deprive you of life's wonders. Live.

For some silver linings in the coronavirus situation, you might want to read my previous post, " My Shelter Diary ," including the excellent comment by "Your Reader in Pennsylvania."

I read this aloud on YouTube.

Marty Nemko, Ph.D ., is a career and personal coach based in Oakland, California, and the author of 10 books.

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Remarks by President   Biden on the COVID- ⁠ 19 Response and Vaccination   Program

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THE PRESIDENT: Good afternoon. I’ve just been briefed by my COVID-19 team on the progress we’re making in our fight against the virus.   Today, I want to provide a brief update on my plan that I announced in early September to accelerate the path out of the pandemic.   It’s working. We’re making progress.   Nationally, daily cases are down 47 percent; hospitalizations are down 38 percent over the past six weeks.   Over the past two weeks, most of the country has improved as well. Case rates are declining in 39 states and hospital rates are declining in 38 states.   We’re down to 66 million — it’s still an unacceptably high number — of unvaccinated people from almost 100 million in July.   That’s important. It’s important progress. But it’s not — now is not the time to let up. We have a lot more to do. We’re in a very critical period as we work to turn the corner on COVID-19.   First, we have to do more to vaccinate the 66 million unvaccinated people in America. It’s essential. The vaccine requirements that we started rolling out in the summer are working. They’re working.   The Labor Department is going to soon be issuing an emergency rule for companies with 100 or more employees to implement vaccination requirements in their — among their workforce.   Every day, we see more businesses implementing vaccination requirements, and the mounting data that shows they work.   Businesses and organizations that are implementing requirements are seeing their vaccination rates rise by an average of 20 percent or more to well over 90 percent — the number of employees vaccinated.   Let’s be clear: Vaccination requirements should not be another issue that divides us. That’s why we continue to battle the misinformation that’s out there, and companies and communities are setting up their — stepping up as well to combat these — the misinformation.   Southwest Airlines at — the head of the pilot — the head of the pilot’s union and its CEO dismissed critics who claim vaccination mandates contributed to flight disruptions. School board members, religious leaders, and doctors across the country are fighting misinformation and educating people about the importance of vaccines.   All of these efforts are going to help us continue moving the dial to eliminate this disease.   Second, we’re going to continue protecting the vaccinated.   This work — this week, the Food and Drug Administration and — the FDA is reviewing the data on Moderna and Johnson & Johnson boosters. We expect a final decision from the FDA and the Centers for Disease Control and Prevention -– the CDC –- in the next couple of weeks.   If they authorize the boosters, which will be strictly made based on the science — that decision will be based on the science — this will mean all three vaccines will be available for boosters.   Already, more than 1 out of 3 eligible seniors have gotten their third shot — the booster. And we’re going to continue to provide that additional protection to seniors and others as we — as we head into the holidays. 

These boosters are free. I’ll say it again: They’re free, available, and convenient to get.   Third point I’d like to make: We need to continue to keep our schools and our students safe. Ninety-six percent of school districts are fully open with children back in the classroom and — for in-person learning.   We have been able to do this because we’ve provided our schools the resources they need to protect children and the educators, as well as the staff that works in the schools.   We’ve been encouraging schools to implement important health measures like masking, testing, and getting everyone vaccinated who is eligible to be vaccinated.   Now, I know parents out there are anxiously waiting for a vaccine for children ages 5 to 11. The good news is the FDA and outside experts from the CDC are set to make its determination as to whether the vaccine will be authorized for that age range in the next few weeks.   If authorized, we are ready. We have purchased enough vaccines for all children between the ages of 5 and 11 in the United States. It will be — it will be convenient for parents to get their children vaccinated at trusted locations, and families will be able to sleep easier at night knowing their kids are protected as well.   Let me close with this: The plan I laid out in September is working. We’re headed in the right direction. We have critical work to do, but we can’t let up now.   My team and I are doing everything we can. But I’m calling on more businesses to step up. I’m calling on more parents to get their children vaccinated when they are eligible. And I’m asking everyone — everyone who hasn’t gotten vaccinated: Please get vaccinated.   That’s how we put this pandemic behind us and accelerate our economic recovery. We can do this.   I’ve said many times: God bless you all, and may God protect our troops.   Thank you very much.   1:00 P.M. EDT

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Persuasive Effects of Message Framing and Narrative Format on Promoting COVID-19 Vaccination: A Study on Chinese College Students

1 HSBC Business School, Peking University, Shenzhen 100871, China; nc.ude.ukp.sbhp@mwey

2 Walter Cronkite School of Journalism and Mass Communication, Arizona State University, Tempe, AZ 85281, USA; ude.usa@11ilnaiq

Associated Data

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

During a public health crisis, the provision and dissemination of health-related information are important for the relevant authorities to keep the public informed. By using different types of message framing, the authorities can effectively guide and persuade people to adopt health-related behaviors (such as vaccination). In this study, a web-based experiment using a 2 × 2 (message framing: gain framing versus loss framing) × (message presentation: narrative versus non-narrative) design was conducted to investigate the effects of different message frames on vaccination promotion. In total, 298 college students were recruited to participate in this study. The results suggest that, for message framing, loss-framed (vs. gain-framed) messages lead to higher intentions to get vaccinated. Furthermore, compared with non-narrative messages, narrative messages are more persuasive in promoting vaccination behavior. However, the interaction effect between gain–loss message framing and narrative framing is not significant. Additionally, perceived severity, perceived benefits, and perceived costs mediate the effect of narrative framing on behavioral intentions. In other words, compared with non-narrative messages, narrative messages lead to higher levels of perceived severity and perceived benefits, and a lower level of perceived costs, which in turn increase intentions to get vaccinated. This paper provides insightful implications for both researchers and practitioners.

1. Introduction

During a public health crisis, the provision and dissemination of health-related information are important for the relevant authorities to keep the public informed. By using different types of message framing, the authorities can effectively guide and persuade people to adopt health-related behaviors (such as vaccination).

Previous studies in the field of health communication focused more on analyzing the effectiveness of specific information contexts and less on the relationships between message framing and behavioral intentions [ 1 , 2 , 3 , 4 , 5 ]. The way people process health-related information is not completely rational [ 6 , 7 ]; this indicates that the sole examination of media presentations cannot precisely measure the real persuasive effects of messages [ 8 , 9 ]. People’s decision-making preferences are also affected by how information is presented [ 10 , 11 , 12 ]. According to framing effect theory, different presentations of health-related information can affect individuals’ decision-making preferences. Therefore, grasping the process of interaction between information and people and designing effective information to influence people’s decision-making processes can produce a positive impact when communicating during a public health crisis.

Due to the asymmetries between people’s responses to and preferences for information expressions and their different attitudes toward various options during the decision-making process [ 13 , 14 , 15 , 16 ], the effects of gain framing and loss framing have been primarily discussed and compared in previous studies. The research proposed that whether the information was presented with benefits or risks would have significant and different impacts on people’s behavioral preferences [ 16 ]. Under the definition of gain–loss framing effect, both “benefit” and “risk” are expressed as a subjective view and personal feeling of possible or assumed consequences. Specifically, health information with the gain frame will focus on defining the gains obtained by people from accepting a specific behavior. The information with loss frame, on the other hand, will highlight the risks associated with the rejection of such a health behavior [ 17 , 18 ]. Then, gain- and loss-framed messages have emerged as the essential tool to examine the framing effect in health communication studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Many studies also found that more attention should be paid to research contexts when examining the effectiveness of message frameworks, and combining framed messages with specific contexts is a necessary aspect to be considered [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].

Moreover, different types of health behaviors have also been introduced as moderators in analyzing the relationships between the framing effect and behavioral intentions [ 17 , 18 ]. Specifically, loss-framed messages have proven to be more persuasive in encouraging detection behaviors [ 19 , 20 , 21 ]; conversely, messages presented in gains are more persuasive in encouraging prevention behaviors [ 22 , 23 , 24 ]. Thus, gain framing may be more effective in promoting vaccination, which has been considered one type of prevention behavior [ 23 , 24 , 25 ]. However, regarding the global COVID-19 pandemic that continues to influence daily life significantly worldwide, it is unknown whether a gain-framed message will be more effective than a loss-framed message in promoting vaccination against COVID-19.

According to exemplification theory, many studies have argued that people pay more attention to information represented with vivid and lucid cases, and, compared with messages expressed with statistical descriptions, those expressed with anecdotes play a greater role in persuasion [ 26 , 27 , 28 , 29 ]. The explorations and findings related to exemplification theory have also contributed to the study of the relationships between narratives and persuasive effects. Narratives are defined as one type of message format associated with a series of events and characters, and compared with non-narratives, narratives tell stories from the first-person perspective [ 29 , 30 ]. Many empirical studies have proven that narrative messages, compared with non-narrative messages, have a greater persuasive effect on promoting health behaviors [ 31 , 32 , 33 ]. In this case, the fictional and fascinating stories presented in narrative messages play a good role in transporting health information to their audiences by providing a sense of familiarity and imaginability and will largely reduce people’s perceptions of fear and uncertainty [ 33 , 34 ]. Based on this, it is also meaningful to examine the effectiveness of narrative messages in the promotion of COVID-19 vaccination.

People’s decisions are closely related to various psychological factors, including cognitions, emotions, attitudes, and intentions [ 35 , 36 , 37 , 38 ]. Some theoretical frameworks, including the Elaboration Likelihood Model (ELM) and the Health Belief Model (HBM), have been used to analyze and predict people’s health behaviors [ 39 , 40 , 41 ]. The ELM provides a general framework for organizing, categorizing, and understanding the fundamental processes underlying the effectiveness of persuasive communications [ 39 ]. As a critical variable in the ELM model, issue involvement is used to measure the importance or relevance of the information to individuals. Thus, some studies combined the theory of the framing effect with the ELM and introduced issue involvement as a mediator to analyze the framing effect on people’s behavioral intentions [ 39 , 42 ]. The HBM has always been seen as one of the most widely used mainstream theoretical frameworks. It is also the earliest theoretical model for exploring people’s attitudes and individual decision preferences. The HBM asserts that individuals’ attitudes and intention to adopt health-related behaviors depend on their health beliefs [ 40 , 41 , 43 ]. The HBM proposes that people’s intentions are caused by their perceived threats of specific diseases and their evaluation of the recommended preventive measures [ 41 , 43 ]. Specifically, four main health beliefs, namely, perceived severity, perceived susceptibility, perceived benefits, and perceived costs, have been extensively discussed [ 44 , 45 , 46 , 47 , 48 ]. Moreover, previous studies have also examined and proven the mediating effects of health beliefs on message framing [ 49 , 50 , 51 ]. Conversely, it has also been proposed that health beliefs significantly mediate the interaction between framed messages and behavioral intentions.

According to the latest Ipsos survey conducted by the World Economic Forum, among more than 18,000 adults from 15 countries, about 73% agreed to get vaccinated against COVID-19; however, perhaps due to concerns about possible side effects resulting from the short clinical trials, 27% disagreed. As a result, the analysis of people’s attitudes and intentions toward COVID-19 vaccination is quite meaningful. Among different groups of people, many studies have focused on understanding the persuasive effects of messages in the promotion of the vaccination behavior of young adults. Specifically, a variety of studies have examined the effects of framing on promoting undergraduate students’ intentions to get the HPV vaccine [ 35 , 52 , 53 ]. For COVID-19 vaccination, increasingly more vaccines are being approved for young adults. However, promoting COVID-19 vaccination among young adults may be challenging, as they believe they are less at risk compared with older adults. Persuading young adults to get vaccinated is meaningful for the vaccination campaign as a whole and is also the key to achieving herd immunity. In addition, according to the latest report released by China’s Ministry of Education, as of 2020, the total enrollment in higher education in China was 41.83 million, with an enrollment rate of 54.4%. Because college students are considered important human resources for social development, their health conditions are associated with the future of the entire nation. Furthermore, the determination of how to improve the persuasiveness of health information to affect college students’ behavioral intentions via the manipulation of different message strategies helps to achieve health education on a larger scale [ 54 ]. Thus, the examination of the effect of framing on the promotion of health behavior intentions makes both academic and practical contributions. Therefore, the present research aims to explore how different message framings affect their persuasiveness in promoting COVID-19 vaccination for young adults.

To inform and examine the effectiveness of framed messages, this research seeks to understand how intentions to get vaccinated are influenced by message framing and message presentation. Furthermore, this research investigates the mediating effects of health beliefs on the relationship between framing and intentions. Specifically, this study aims to answer the following research questions. (1) Do gain-framed and loss-framed messages have different persuasive effects on COVID-19 vaccination intention? (2) Do narrative messages and non-narrative messages have different persuasive effects on COVID-19 vaccination intention? (3) Do message frames interact with narrative framing to influence COVID-19 vaccination intention? (4) How do narrative and non-narrative messages affect respondents’ health beliefs? (5) Are the effects on vaccination intention mediated by health beliefs?

2. Materials and Methods

2.1. study design and participants.

A web-based experiment using a 2 × 2 (message framing: gain framing versus loss framing) × (message presentation: narrative versus non-narrative) design was conducted. College students were recruited from an online panel run by Wenjuanxing (available online: https://www.wjx.cn/ (accessed on 19 March 2021)), which is like Amazon’s Mechanical Turk and Prolific. Students who have never received any COVID-19 vaccine were included in this study. The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Discipline and Ethics Committee of Peking University HSBC Business School (PHBS0401, 21 April 2021). Following Simmons, Nelson, and Simonsohn’s recommendations [ 55 ], we planned to target at least 50 per cell in online studies. As the final sample, 298 students ( M age = 21.44; 46.3% female; 63.7% undergraduate students and 36.3% graduate students (including 0.7% Ph.D. students) were recruited to participate in this study. The participants were invited to browse a web page, where they were shown a brief introduction and asked to sign an informed consent form. Once they agreed to participate, they were randomly assigned to one of the four experimental conditions. The participants were primarily asked to report their basic knowledge about COVID-19 and the associated vaccines. Then, the participants were presented with one piece of health messaging promoting COVID-19 vaccination. The message framing was manipulated; the message was either gain-framed or loss-framed. The message presentation was also manipulated; the message was presented in either a narrative or non-narrative format. After reading the message stimuli, the participants were asked to answer a series of questions. A set of Likert scales was used to measure several variables, including the behavioral intention to get the COVID-19 vaccine and health beliefs toward vaccination. Participants were finally asked to report demographic information, including their age, gender, location, education level, and income level.

The final sample was composed of 298 college students. The participants in this experiment lived in 29 provinces in China, accounting for 85% of the total number of provinces in the country. Based on the ratio of the geographical distribution of participants, the participants were evenly distributed between east-west and north-south. Thus, the participants could represent the basic characteristics of Chinese college students, and the bias caused by regions could be effectively avoided. A brief survey was conducted to test the students’ basic knowledge and cognition related to both COVID-19 and the COVID-19 vaccines. This survey found that no participants in the selected sample had been infected with COVID-19, 84.3% said that they had previously heard of the COVID-19 vaccine, and 15.7% said that they had not previously heard of it. Most participants believed that they had a good understanding of the mechanism of the COVID-19 vaccine and believed that accepting vaccination is quite beneficial to human health; however, only half of the Chinese population believe that their daily life is closely related to the COVID-19 vaccine.

2.2. Message Stimuli

The health messages were presented as newsletters, which provided basic information regarding COVID-19 and the COVID-19 vaccines. Then, two features of the message were designed, including message framing and message presentation. Following prior studies [ 56 , 57 ], the gain-framed messages conveyed the benefits of getting vaccinated, while the loss-framed messages focused on the potential detriments of not getting vaccinated. In addition, following previous research [ 35 , 54 ], the narrative messages were manipulated by presenting a personal story from the first-person perspective. In the non-narrative messages, no specific characters were involved, and the messages conveyed an objective conclusion. The message stimuli are reported in Table 1 .

Message stimuli in experiment conditions.

2.3. Measurements

Unless indicated otherwise, the responses to items were given on 5-point Likert scales. The Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) as endpoints and the average mean values of related items were considered as indexes for the related variables. Before measuring all related variables, this study conducted the manipulation checks to examine the efficiency and reliability of the design of message stimuli. This study then measured the dependent variable, that is, intention to get the COVID-19 vaccine. Then, the present study continued to measure four main health beliefs as mediators, which include perceived severity, perceived susceptibility, perceived benefits, and perceived costs. Finally, this study measured demographical variables, including the participants’ age, gender, education level, and Internet literacy.

2.3.1. Manipulation Checks

The present study conducted a set of manipulation checks of the framed messages before measuring all related variables. The purpose of this is to test the effectiveness and accuracy of the message designs. The manipulation checks contained two dimensions of measurement: one is to measure how much participants think this is a piece of positive or negative message, and the other is to measure how much participants think this message is a narrative or non-narrative one. This study asked participants to complete the scoring of the following questions based on their feelings after reading the assigned health message, and the Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) was also used in the questionnaire. Specifically, six items were included: “This information emphasizes the benefits of getting COVID-19 vaccination”; “This information emphasizes the risk of not getting COVID-19 vaccination”; “This information emphasizes that getting COVID-19 vaccination will bring you positive effects”; “This information emphasizes that getting COVID-19 vaccination will bring you negative effects”; “This information is written in a person’s narrative”; “This information is written in an objective style”.

2.3.2. Intention to Get the COVID-19 Vaccine

The measurement of the intention to get the COVID-19 vaccine was adapted from past studies [ 54 ] that measured people’s intentions to get a vaccination in both the short term and the long term. Participants were asked to respond to three questions (e.g., “How likely would you be to get the COVID-19 vaccine sometime soon?”; Cronbach’s α = 0.77, M = 3.71, SD = 1.14). Higher scores indicated participants’ stronger intention to get vaccinated.

2.3.3. Health Beliefs

Scales adapted from previous studies [ 57 , 58 ] were used to measure the four specific health beliefs. Three items assessed perceived susceptibility by measuring the perception of risks associated with COVID-19 and the possibility of infection (e.g., “I may get COVID-19”; Cronbach’s α = 0.89, M = 3.26, SD = 1.41). Three items assessed perceived severity by measuring the perception of the negative consequences caused by COVID-19 (e.g., “I believe that COVID-19 will result in severe health problems”; Cronbach’s α = 0.71, M = 3.72, SD = 1.07). Another three questions were posed to test perceived benefits by measuring the evaluation of vaccine efficacy in preventing COVID-19 (e.g., “I believe if I get the COVID-19 vaccine, I will be less likely to get COVID-19”; Cronbach’s α = 0.76, M = 3.74, SD = 1.15). Furthermore, three items were used to assess perceived costs by measuring the perception of barriers from getting vaccinated (i.e., “I worry about the short-term side effects of the COVID-19 vaccine”; “I worry that the COVID-19 vaccine might negatively affect my body”; “I worry that the COVID-19 vaccine might have unknown long-term side effects”; Cronbach’s α = 0.83, M = 2.39, SD = 1.26). Higher scores indicated stronger health beliefs.

2.3.4. Control Variables

The choice of college students as research participants may have led to greater similarity between groups. The age, gender, education level, and Internet literacy of the participants were therefore included in the analyses as control variables.

2.4. Data Analysis Strategies

To test the research questions, series of analyses of variance (ANOVAs) and analyses of mediation were conducted. Via ANOVA, the differences between experimental groups were compared while controlling for demographic variables. The main effects of message framing and message presentation were first examined, after which the interaction effect between message framing and message presentation was tested. The PROCESS macro (version 3.5, Andrew F. Hayes, Columbus, OH, USA) for SPSS 27 (IBM, Armonk, NY, USA) was used for mediation analysis (Model 4) because it adopts a bootstrap method to estimate the mediating effect [ 59 ]. Via mediation analyses, the mediating effects of the four health beliefs on the relationship between narrative message presentation and the intention to get the COVID-19 vaccine were examined.

3.1. Manipulation Checks Results

Manipulation checks were conducted on message framing (gain framing versus loss framing) and message format (narrative versus non-narrative) using a series of independent t-tests. The results showed that participants in the gain-framed message condition perceived the message to focus more on expressing the positive information related to vaccination ( M = 3.966, SD = 0.519) as compared to those in the loss-framed message condition ( M = 3.3226, SD = 1.2709), t = 5.647, p < 0.001. Moreover, participants in the narrative message condition were more likely to perceive the message to be presented from the personal perspective ( M = 4.1769, SD = 0.7375) than were those in the non-narrative message condition ( M = 2.0204, SD = 0.8148), t = 23.7902, p < 0.001. Therefore, both manipulations were successful.

3.2. Main Effects

To answer RQ1, whether gain-framed and loss-framed messages have different persuasive effects on COVID-19 vaccination intention, the results show that for message framing, the loss-framed message, compared with the gain-framed message, promoted the intention to get the COVID-19 vaccine. A one-way ANOVA was conducted on the COVID-19 vaccination intention, and message framing was entered as the independent variable. As shown in Table 2 , the results indicate that the main effects of message framing on vaccination intention were statistically significant, F (1, 296) = 9.855, p = 0.002. Specifically, the loss-framed message led to stronger behavioral intention ( M loss-framed = 3.895 versus M gain-framed = 3.563). Furthermore, another one-way ANOVA was performed to answer RQ2, which is whether narrative and non-narrative messages have different persuasive effects. The message format was introduced as the independent variable, and vaccination intention was considered as the dependent variable. The results indicate that the main effects of the message format on vaccination intention were statistically significant, F (1, 296) = 11.334, p = 0.001. Specifically, the narrative message promoted the intention to get the COVID-19 vaccine ( M narrative = 3.908 versus M non-narrative = 3.552). The interaction between the loss-gain framing and narrative framing was examined, and the interaction effect on vaccination intention was not found to be statistically significant. Thus, for RQ3, whether gain–loss framing interacts with narrative framing on COVID-19 vaccination intention, the interaction was not statistically significant.

Means and standard deviation related to research questions 1–2.

3.3. Mediation Effects

RQ4 tried to investigate whether and how narrative and non-narrative messages affect college students’ health beliefs, including perceived susceptibility, perceived severity, perceived benefits, and perceived costs. To address this question, an analysis of mediation was conducted by using the PROCESS macro in SPSS, and the model 4 was selected. Using a bootstrap method, this study selected a sample size of 5000. Narrative message presentation was entered as the independent variable, vaccination intention was introduced as the dependent variable, and health beliefs were included as mediators. As shown in Table 3 , the results indicate that the mediation effects of health beliefs on narrative framing were partially significant. When testing the mediation effects of perceived severity, perceived benefits, and perceived costs, their confidence intervals of the bootstrap did not include zero, which means that those three variables had significant mediating effects on narrative framing. Specifically, the mediating effects of perceived severity (BootLLCI = 0.0186, BootULCI = 0.0868), perceived benefits (BootLLCI = 0.0137, BootULCI = 0.1030), and perceived costs ( BootLLCI = 0.0046, BootULCI = 0.0660) were statistically significant in the 95% bias-corrected bootstrap confidence interval. Therefore, perceived severity, perceived benefits, and perceived costs mediate the relationship between narrative framing and behavioral intention. RQ5 then investigated whether the health beliefs mediate the relationship between narrative framing and intentions to get the vaccination. To address this research question, the coefficients of the mediating models were examined to analyze the directions of the mediating effects and the results were shown in Figure 1 . Specifically, compared with non-narrative messages, narrative messages led to a higher level of the perceived severity of COVID-19 and the perceived benefits of the COVID-19 vaccine. Furthermore, compared with the non-narrative messages, the narrative messages led to a lower level of perceived costs. In conclusion, narrative messages were found to lead to higher levels of perceived severity and perceived benefits, while they led to a lower level of perceived costs, and therefore were ultimately found to promote the intention to get the COVID-19 vaccine.

Mediating model on narrative framing.

Mediation effects related to research questions 4–5.

4. Discussion

This present research is one of the first few studies to investigate the effects of message framing and narrative message presentation on promoting COVID-19 vaccination. Specifically, the persuasiveness of gain-framed versus loss-framed messages was compared, as was the persuasiveness of narrative versus non-narrative messages. Because the research targets were Chinese college students, it is difficult to compare the results of the present research with those of previous studies due to the lack of surveys conducted among the same group. This research, however, revealed some notable findings in the prediction of the intention to get the COVID-19 vaccine.

A central thesis of this research is that vaccination, unlike other preventative health-related behaviors, is associated with higher risks due to side effects and other safety concerns. Moreover, under the influence of public opinion, the anxiety of the public will spread, causing a large portion of the population to be reluctant to get vaccinated even if they believe that vaccination is a beneficial behavior. Drawing upon prospect theory [ 16 , 53 , 60 ], people will prefer less risky behavior when those risks are expressed salient. Because people will exhibit greater aversion to the risks caused by vaccination, loss-framed messages are more likely to enhance their intention to get the COVID-19 vaccine. The results of the controlled experiment were found to be largely consistent with the research questions, and the findings are consistent with the results of some previous studies conducted in other contexts [ 33 , 34 , 53 , 54 ].

Similarly, this research also posited that narrative messages are more persuasive than non-narrative messages to promote COVID-19 vaccination behavior. Narrative descriptions associated with fictional and fascinating stories will benefit people to build a more specific and concrete understanding of the issue [ 28 , 29 , 30 , 60 ]. Furthermore, compared with didactic and objective arguments, messages in narrative format provide people with more familiarity and imaginability, and will therefore be more persuasive in promoting behavioral intentions. Consistent with the prediction, the results showed that narrative messages, both gain-framed and loss-framed, are more persuasive than non-narrative messages in promoting vaccination. These findings are consistent with those of previous studies that have suggested the greater effectiveness of narrative messages in promoting vaccination [ 33 , 34 , 61 ].

In addition to examining the effects of message framing and presentation, this research examined the mediating roles of various health beliefs on the interaction between narrative framing and vaccination intention. Drawing upon the HBM, people’s decision-making processes can be influenced by their evaluations of potential threats and efficacy [ 41 , 42 , 62 ]; thus, many studies have introduced health beliefs into a framing effect model to examine their mediating effects [ 34 , 48 , 49 ]. In the present research, it was found that health beliefs significantly mediate framing effects; this is consistent with the findings of some previous studies [ 33 , 62 , 63 , 64 ], even though they were focused on other types of health behaviors or other framing effects. Specifically, narrative (versus non-narrative) messages will lead to higher levels of perceived severity and perceived benefits and will simultaneously lead to a lower level of perceived costs; thus, they will promote the intention to get the COVID-19 vaccine. Messages conveyed in narrative format will enhance people’s perceived threats of COVID-19 and the perceived efficacy of the vaccines. Furthermore, messages presented as narratives will help people to better understand and avoid the well-demonstrated risks, and, conversely, will lessen their concerns about vaccine side effects and other safety barriers.

Of course, all the conclusions of this research must be evaluated in consideration of several limitations. This research failed to introduce discrete emotions as mediators in analyzing the interactions between framing effects and intentions. Although the research fully measured and investigated people’s health beliefs, people’s emotions, including fear, sadness, guilt, and relief, can also lead to different behavioral responses [ 30 , 62 , 65 , 66 , 67 , 68 , 69 , 70 ]. Future research may seek to examine the mediating roles of emotions on framing effects, especially the mediating role of fear. People with fear tend to retreat from loss-framed stimuli and will avoid any behavior to address them [ 65 , 71 , 72 ]. In other words, people can be too afraid to make any possible attempt, even if they clearly know that such an attempt is beneficial to them. Additionally, future research can introduce the Extended Parallel Process Model (EPPM) into the discussion. Compared with the HBM, the EPPM can better measure people’s perceived threats and efficacy and can therefore be used to comprehensively examine the effect of framing on the persuasion of people’s behavioral intentions [ 56 ]. Finally, the present study did not examine the roles of individual affective and cognitive orientations on promoting behavioral intentions. This study merely focused on analyzing the persuasiveness of messages with different expressions. However, people’s affective and cognitive attitudes should also be introduced into the model. According to the theory of matching effect, if the framed message matches an individual’s affective and cognitive orientations, it will enhance the effectiveness of persuasion [ 73 ]. In other words, matches between people’s psychological states and the message will make it more persuasive [ 74 , 75 , 76 ]. Those related theories do give great inspiration for future research. According to the findings in this study, loss framing, compared with gain framing, is more persuasive. Additionally, narratives also have a more significant persuasive effect compared with non-narratives. However, this study did not take affective orientation and cognitive orientations into consideration. What type of framed messages can significantly match individual’s psychological states and will better trigger their behavioral intentions? In future research, it may be necessary to add more variables to measure the dimensions of personal psychological characteristics to better measure the influence of emotion and cognition orientations on persuasiveness.

5. Conclusions

In conclusion, the results of this study emphasize that the persuasive effects of various message expressions are significantly different. First, the difference between gain framing and loss framing in the promotion of vaccination intention was proven to be significant. Specifically, loss-framed messages are more persuasive than gain-framed messages in promoting COVID-19 vaccination. Because vaccination is one type of health behavior associated with risk, according to prospect theory, loss-framed messages are more persuasive. Second, the difference between narrative and non-narrative messages in encouraging vaccination was also proven to be significant. In other words, narrative messages are more effective than messages presented in a non-narrative format, as narrative messages allow people to better understand the potential risks of rejecting vaccination against COVID-19 or the benefits of getting the vaccine. Furthermore, narrative descriptions will enhance people’s familiarity with the framed message and more strongly trigger their intention to get the COVID-19 vaccine. Moreover, the mediating effects of health beliefs, including perceived severity, perceived benefits, and perceived costs, were proven to be significant. Specifically, messages conveyed in a narrative format will increase people’s perceptions of the severity of COVID-19 and the benefits obtained from getting the vaccine. Additionally, perceived costs will play a negative mediating role, i.e., narrative messages will result in a lower level of perceived costs and will make people more likely to get the COVID-19 vaccine.

Author Contributions

Conceptualization, W.Y. and Q.L.; data curation, Q.L.; methodology, Q.L. and S.Y.; supervision, W.Y. and S.Y.; writing—original draft, Q.L.; writing—review & editing, W.Y. and S.Y. All authors have read and agreed to the published version of the manuscript.

This research was supported by The National Social Science Fund of China (“Research on Algorithm-mediated Online Platform Labor”, grant number 19BXW098).

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Discipline and Ethics Committee of Peking University HSBC Business School (PHBS0401, 21 April 2021).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

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